高分级神经胶质瘤术后同期放化疗的疗效

Efficacy of post-operative treatment with concurrent chemoradiation for high-grade gliomas

目的:分析高分级神经胶质瘤术后调强放疗(IMRT)联合替莫唑胺化疗的疗效。方法:2005年1月-2009年12月共53例高分级神经胶质瘤术后患者接受IMRT联合替莫唑胺化疗。放疗方案为IM-RT,同期加量,PTV2处方剂量50.4 Gy/28f,PTV1处方剂量58.8 Gy/28f,PTVtb处方剂量61.6 Gy/28f,PGTV处方剂量64.4 Gy/28f。在放疗期间每天口服替莫唑胺75 mg.m-2。放疗结束休息4周后循环口服化疗,放疗后的第1个疗程每天口服150 mg.m-2,连续5 d,第2个疗程起改为每天口服200 mg.m-2,28 d为1个疗程,计划接受4个周期辅助化疗。记录治疗反应,计算总生存率和局部无进展生存率。结果:本组患者急性不良反应多为1～2级,无4级以上反应,有3例发生后期放射性脑损死。1,2和3年总生存率分别为75.5%,52.8%和39.6%,1,2和3年局部无进展生存率分别为67.9%,45.3%和35.8%。结论:术后IMRT联合替莫唑胺治疗高分级神经胶质瘤可以获得较为理想的临床疗效,治疗后急性不良反应轻微,晚期不良反应可接受。

Objective： To analyze the efficacy of post-operative treatment with intensity modulated radiation therapy（IMRT） plus temozolomide for high-grade gliomas.Methods： From January 2005 to December 2009,53 patients with high-grade cerebral gliomas received post-operative treatment with IMRT plus temozolomide with simultaneous boosted radiation technique.The prescribed dose of planning target volume 2（PTV2） was 50.4 Gy/28f,and PTV1,PTVtb,and PGTV were 58.8 Gy/28f,61.6 Gy/28f,and 64.4 Gy/28f,respectively.Concurrent chemotherapy was performed with oral temozolomide 75 mg·m-2 daily at the initiation of radiation.Patients rested for 4 weeks after the completion of radiation.Then patients received four-cycles of oral chemotherapy（28 days for each cycle）.Temozolomide was administered orally at 150 mg·m-2 daily for continuous 5 days in the first cycle of chemotherapy,and its dose was increased to 200 mg·m-2 daily in the latter three-cycle chemotherapy.Toxicities were observed and recorded,and overall survival and local-progress free survival rate were calculated.Results： Most acute toxicities were grade 1 or 2,and no grade 4 toxicities occurred.Late cerebral radiation necrosis occurred in 3 patients.The rates of 1-,2-,and 3-year overall survival were 75.5%,52.8% and 39.6%;and the rates of 1-,2-,and 3-year local-progress free survival were 67.9%,45.3%,and 35.8%,respectively.Conclusion： Ideal clinical efficacy has been acquired for high-grade cerebral gliomas after receiving post-operative treatment with IMRT plus temozolomide,the acute toxicities are minor,and the late side reactions are receptive.